Imaging of Dermatofibrosarcoma Protuberans of Breast
Shi-Zuo Liu, Tzu-Lung Ho, Soa-Min Hsu, Hui-Lun Zhan and Chen-Pin Chou
The Breast Journal 2010 16;5:541–543
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Dermatofibrosarcoma protuberans (DFSP) is a rare superficial soft tissue malignancy. We report a 45-year-old woman diagnosed with DFSP involving the breast. Ultrasound of DFSP revealed a heteroechogenetic breast mass, which showed normal adjacent dermis. Mammography disclosed a high-density mass without microcalcification. MRI showed an enhancing lobulated lesion with small area of cystic change and hemorrhage. The patient underwent excision biopsy and pathology revealed DFSP of the breast. DFSP involving the breast is rare and preoperative diagnosis by imaging could be a challenge for clinicians.
A solitary mixed echogenicity and ill-defined soft tissue with no microcalcification located in the subdermal region could indicate the presence of DFSP
Sunday, 12 September 2010
Lobular Neoplasia of the Breast
Lobular Neoplasia of the Breast
Ramachandran Venkitaraman
The Breast Journal 2010 16;5:519–528
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Lobular neoplasia is increasingly being detected, probably due to the widespread screening for breast malignancies. The understanding of lobular neoplasia is undergoing a paradigm shift, from being considered a predictor of recurrence to being considered a pre-invasive lesion, based on molecular studies suggesting a clonal link with invasive lobular cancer.
The management of patients diagnosed to have lobular neoplasia is in evolution, with the increasing need for risk stratification and hence the necessity to identify this entity separately as either lobular carcinoma in-situ and atypical lobular hyperplasia. The indications for wide local excision for patients diagnosed to have lobular neoplasia on biopsy are being defined.
The evidence for preventive strategies like hormonal treatment with Tamoxifen or aromatase inhibitors for high risk patients is increasing, with the results from prospective interventional trials. The role of screening magnetic resonance imaging for surveillance of high risk patients with lobular neoplasia is under evaluation
Ramachandran Venkitaraman
The Breast Journal 2010 16;5:519–528
Link to Journal
Lobular neoplasia is increasingly being detected, probably due to the widespread screening for breast malignancies. The understanding of lobular neoplasia is undergoing a paradigm shift, from being considered a predictor of recurrence to being considered a pre-invasive lesion, based on molecular studies suggesting a clonal link with invasive lobular cancer.
The management of patients diagnosed to have lobular neoplasia is in evolution, with the increasing need for risk stratification and hence the necessity to identify this entity separately as either lobular carcinoma in-situ and atypical lobular hyperplasia. The indications for wide local excision for patients diagnosed to have lobular neoplasia on biopsy are being defined.
The evidence for preventive strategies like hormonal treatment with Tamoxifen or aromatase inhibitors for high risk patients is increasing, with the results from prospective interventional trials. The role of screening magnetic resonance imaging for surveillance of high risk patients with lobular neoplasia is under evaluation
Imaging Characteristics of Male Breast Disease
Imaging Characteristics of Male Breast Disease
Zehra Hilal Adibelli, Ozgur Oztekin, Işil Gunhan-Bilgen, Hakan Postaci, Adam Uslu and Enver Ilhan
The Breast Journal 2010 16;5:510–518
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The purpose of the study was to describe the imaging findings of male breast disease. One hundred and sixty-four male patients, who underwent mammography and ultrasonography (US) between January 1999 and December 2008, were retrospectively evaluated. Seventy-five patients (46%) underwent biopsy, and 89 patients (54%) were diagnosed radiologically. The radiologic and pathologic diagnoses in 164 cases of this series were 13 cancers (8%), including one ipsilateral and one contralateral breast cancers, 147 cases of gynecomastia (90%), one fibroadenoma (0.6%), two cases of fibrocystic disease of the breast (1.2%), and one epidermoid inclusion cyst (0.6%).
Three mammographic patterns were adequate to describe all 147 cases of gynecomastia in our series: 53 patients (36%) had nodular gynecomastia, 46 patients (31%) had dendritic gynecomastia, and 48 patients (33%) had diffuse gynecomastia. Gynecomastia was unilateral in 65% of cases (n = 95), and bilateral in 35% of cases (n = 52). On physical examination, two of the malignant lesions had no clinic features of malignancy (15%). On mammography, 11 of 13 malignant masses were demonstrated (85%). A mass with microcalcifications was seen on mammograms in one case (9%). The contours of the masses were irregular in nine cases (82%), well-circumscribed in two cases (18%). The location of the masses was retroareolar in seven cases (64%) and eccentric to the nipple in four cases (36%). The size of the masses varied between 0.5 cm and 5 cm (mean 2.4 cm). Nipple retraction was evident in five cases (45%), and skin thickening in four cases (36%). All of the malignant masses were demonstrated on ultrasound; however, one of them was seen retrospectively after mammography. All of the masses were hypoechoic and solid, the contours were well-defined and smooth in two masses (15%), and irregular in 11 masses (85%), and five masses (39%) had posterior prominent shadowing. Axillary lymphadenopathia was detected in two cases (15%). One patient had a previous contralateral breast cancer, and one had an ipsilateral.
On mammography, breast cancer characteristically exhibits an irregular subareolar mass, nipple retraction, and skin ulceration or thickening, but sometimes breast cancer has a well-circumscribed contour and punctuated microcalcifications. Ultrasonography is essential and useful for further characterization and helpful for demonstrating lymphadenopathies of the axillary region
Zehra Hilal Adibelli, Ozgur Oztekin, Işil Gunhan-Bilgen, Hakan Postaci, Adam Uslu and Enver Ilhan
The Breast Journal 2010 16;5:510–518
Link to Journal
The purpose of the study was to describe the imaging findings of male breast disease. One hundred and sixty-four male patients, who underwent mammography and ultrasonography (US) between January 1999 and December 2008, were retrospectively evaluated. Seventy-five patients (46%) underwent biopsy, and 89 patients (54%) were diagnosed radiologically. The radiologic and pathologic diagnoses in 164 cases of this series were 13 cancers (8%), including one ipsilateral and one contralateral breast cancers, 147 cases of gynecomastia (90%), one fibroadenoma (0.6%), two cases of fibrocystic disease of the breast (1.2%), and one epidermoid inclusion cyst (0.6%).
Three mammographic patterns were adequate to describe all 147 cases of gynecomastia in our series: 53 patients (36%) had nodular gynecomastia, 46 patients (31%) had dendritic gynecomastia, and 48 patients (33%) had diffuse gynecomastia. Gynecomastia was unilateral in 65% of cases (n = 95), and bilateral in 35% of cases (n = 52). On physical examination, two of the malignant lesions had no clinic features of malignancy (15%). On mammography, 11 of 13 malignant masses were demonstrated (85%). A mass with microcalcifications was seen on mammograms in one case (9%). The contours of the masses were irregular in nine cases (82%), well-circumscribed in two cases (18%). The location of the masses was retroareolar in seven cases (64%) and eccentric to the nipple in four cases (36%). The size of the masses varied between 0.5 cm and 5 cm (mean 2.4 cm). Nipple retraction was evident in five cases (45%), and skin thickening in four cases (36%). All of the malignant masses were demonstrated on ultrasound; however, one of them was seen retrospectively after mammography. All of the masses were hypoechoic and solid, the contours were well-defined and smooth in two masses (15%), and irregular in 11 masses (85%), and five masses (39%) had posterior prominent shadowing. Axillary lymphadenopathia was detected in two cases (15%). One patient had a previous contralateral breast cancer, and one had an ipsilateral.
On mammography, breast cancer characteristically exhibits an irregular subareolar mass, nipple retraction, and skin ulceration or thickening, but sometimes breast cancer has a well-circumscribed contour and punctuated microcalcifications. Ultrasonography is essential and useful for further characterization and helpful for demonstrating lymphadenopathies of the axillary region
Computer-assisted Diagnosis in Full-field Digital Mammography—Results in Dependence of Readers Experiences
Computer-assisted Diagnosis in Full-field Digital Mammography—Results in Dependence of Readers Experiences
Christian Sohns, Besim Angic, Samuel Sossalla, Frank Konietschke and Silvia Obenauer
The Breast Journal 2010 16;5:490–497
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The object of this study was to assess the clinical usefulness of computer-assisted diagnosis (CAD) in the interpretation of early-research, benign and malignant mammograms in dependence on readers’ experience with CAD. CAD was applied on digital mammograms of 303 patients who were divided into three groups: early-research (n = 103), benign (n = 102) and malignant group (n = 98). Mammograms were analyzed by three readers with different experience in evaluating mammograms (medical student, an assistant and an attending physician specifically trained in mammography). All images were presented accidentally with and without the influence of CAD and from different patient groups. The mammograms were classified according to BI-RADS classification.
To evaluate readers’ sensitivity and specificity with and without the application of the CAD system, ROC analysis and the corresponding area under the curve (AUC) were evaluated for each reader. Afterwards significant differences of the accuracy according to readers experience and according to the assistance of the CAD system were calculated.
All readers have an account of accuracy by using CAD in both patient groups. The highest benefit has the student (10% increase of the AUC) followed by the resident (4%) and at least followed by the mammography fellow (3%). There are significant varieties of the accuracy in addiction to the readers’ experience and to the examination method with and without CAD system. Patient group has not a significant influence to the elevation of accuracy by using the CAD. All three readers have nearly the same increase of AUC in the examinations of malignant and early-research group summarized and of the malignant group only. Finally, the increase of accuracy depends on the readers’ experience. For all patient groups CAD-application causes a steeply increase of the ROC curve and consequently a gain of sensitivity
Christian Sohns, Besim Angic, Samuel Sossalla, Frank Konietschke and Silvia Obenauer
The Breast Journal 2010 16;5:490–497
Link to Journal
The object of this study was to assess the clinical usefulness of computer-assisted diagnosis (CAD) in the interpretation of early-research, benign and malignant mammograms in dependence on readers’ experience with CAD. CAD was applied on digital mammograms of 303 patients who were divided into three groups: early-research (n = 103), benign (n = 102) and malignant group (n = 98). Mammograms were analyzed by three readers with different experience in evaluating mammograms (medical student, an assistant and an attending physician specifically trained in mammography). All images were presented accidentally with and without the influence of CAD and from different patient groups. The mammograms were classified according to BI-RADS classification.
To evaluate readers’ sensitivity and specificity with and without the application of the CAD system, ROC analysis and the corresponding area under the curve (AUC) were evaluated for each reader. Afterwards significant differences of the accuracy according to readers experience and according to the assistance of the CAD system were calculated.
All readers have an account of accuracy by using CAD in both patient groups. The highest benefit has the student (10% increase of the AUC) followed by the resident (4%) and at least followed by the mammography fellow (3%). There are significant varieties of the accuracy in addiction to the readers’ experience and to the examination method with and without CAD system. Patient group has not a significant influence to the elevation of accuracy by using the CAD. All three readers have nearly the same increase of AUC in the examinations of malignant and early-research group summarized and of the malignant group only. Finally, the increase of accuracy depends on the readers’ experience. For all patient groups CAD-application causes a steeply increase of the ROC curve and consequently a gain of sensitivity
Axillary Ultrasound Assessment in Primary Breast Cancer: An Audit of 653 Cases
Axillary Ultrasound Assessment in Primary Breast Cancer: An Audit of 653 Cases
Pippa Mills, Ali Sever, Jenny Weeks, David Fish, Sue Jones and Peter Jones
The Breast Journal
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Axillary lymph node status is an important factor in determining the prognosis and treatment in patients with invasive breast cancer. The introduction of the sentinel lymph node biopsy technique in the axilla has significantly reduced the number of patients requiring an axillary clearance procedure. However, a proportion of patients will be found to have axillary metastases after a sentinel node biopsy and will then require a second axillary surgical procedure. A retrospective audit of 653 consecutive patients presenting with invasive breast cancer showed a preoperative diagnosis rate of axillary disease of 23% using axillary ultrasound and fine-needle aspiration (FNA) together. We performed 232 axillary FNAs to diagnose 150 positive axillae. This avoided the need for a second operation in 150 women.
The negative predictive value for axillary metastases using this technique was 79%. Overall accuracy was 84%.
Pippa Mills, Ali Sever, Jenny Weeks, David Fish, Sue Jones and Peter Jones
The Breast Journal
Link to Journal
Axillary lymph node status is an important factor in determining the prognosis and treatment in patients with invasive breast cancer. The introduction of the sentinel lymph node biopsy technique in the axilla has significantly reduced the number of patients requiring an axillary clearance procedure. However, a proportion of patients will be found to have axillary metastases after a sentinel node biopsy and will then require a second axillary surgical procedure. A retrospective audit of 653 consecutive patients presenting with invasive breast cancer showed a preoperative diagnosis rate of axillary disease of 23% using axillary ultrasound and fine-needle aspiration (FNA) together. We performed 232 axillary FNAs to diagnose 150 positive axillae. This avoided the need for a second operation in 150 women.
The negative predictive value for axillary metastases using this technique was 79%. Overall accuracy was 84%.
Wednesday, 18 August 2010
The Utility of Breast MRI in the Management of Breast Cancer
The Utility of Breast MRI in the Management of Breast Cancer
Paige Teller, Valerie J. Jefford, Sheryl G. A. Gabram, Mary Newell and Grant W. Carlson
The Breast Journal 2010, 16;4:394–403
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Breast magnetic resonance imaging (MRI) is increasingly used in the evaluation of breast cancer. The impact of this modality on patient management at a single institution is evaluated in this paper. A retrospective review was performed for 114 breast cancer patients who had breast MRI as part of their diagnostic evaluation. Clinical information, mammograms, breast ultrasounds and MRI scans were reviewed to determine whether the MRI findings led to a change in patient management. Outcomes as the result of breast MRI were stratified as favorable and unfavorable. Ninety-five patients who had complete clinical, radiologic, and pathologic data were identified. The indications for breast MRI included: high risk screening (n = 3), diagnostic evaluation of disease after neo-adjuvant chemotherapy (n = 24) or prior to re-excision (n = 8), extent of in situ ductal, infiltrating ductal or infiltrating lobular disease histology (DCIS n = 3, IDC n = 24, ILC n = 17), identification of unknown primary (n = 2), assessment of contralateral breast (n = 4), recurrence surveillance (n = 5), and other (n = 5). MRI was concordant with clinical findings and other modalities in 70.5% of cases. MRI altered planned clinical management in 28 of 95 patients (29.5%). Management changes were favorable in 21 patients (75%). Diagnostic evaluation of the breast by MRI alters patient management in 30% of cases depending upon the indications. Alteration in patient management is favorable in 75% of cases.
Evaluation of the breast by MRI alters the clinical management of nearly one-third of patients. Changes are favorable for the majority of these cases. Patients undergoing evaluation for contralateral disease, invasive lobular carcinoma and assessment of chemotherapeutic response may derive a more meaningful benefit from MRI
Paige Teller, Valerie J. Jefford, Sheryl G. A. Gabram, Mary Newell and Grant W. Carlson
The Breast Journal 2010, 16;4:394–403
Link to Journal
Breast magnetic resonance imaging (MRI) is increasingly used in the evaluation of breast cancer. The impact of this modality on patient management at a single institution is evaluated in this paper. A retrospective review was performed for 114 breast cancer patients who had breast MRI as part of their diagnostic evaluation. Clinical information, mammograms, breast ultrasounds and MRI scans were reviewed to determine whether the MRI findings led to a change in patient management. Outcomes as the result of breast MRI were stratified as favorable and unfavorable. Ninety-five patients who had complete clinical, radiologic, and pathologic data were identified. The indications for breast MRI included: high risk screening (n = 3), diagnostic evaluation of disease after neo-adjuvant chemotherapy (n = 24) or prior to re-excision (n = 8), extent of in situ ductal, infiltrating ductal or infiltrating lobular disease histology (DCIS n = 3, IDC n = 24, ILC n = 17), identification of unknown primary (n = 2), assessment of contralateral breast (n = 4), recurrence surveillance (n = 5), and other (n = 5). MRI was concordant with clinical findings and other modalities in 70.5% of cases. MRI altered planned clinical management in 28 of 95 patients (29.5%). Management changes were favorable in 21 patients (75%). Diagnostic evaluation of the breast by MRI alters patient management in 30% of cases depending upon the indications. Alteration in patient management is favorable in 75% of cases.
Evaluation of the breast by MRI alters the clinical management of nearly one-third of patients. Changes are favorable for the majority of these cases. Patients undergoing evaluation for contralateral disease, invasive lobular carcinoma and assessment of chemotherapeutic response may derive a more meaningful benefit from MRI
Flat Epithelial Atypia on Breast Needle Core Biopsy: A Retrospective Study with Clinical-Pathological Correlation
Flat Epithelial Atypia on Breast Needle Core Biopsy: A Retrospective Study with Clinical-Pathological Correlation
Tsu-Yee Joseph Lee, Rebecca F. MacIntosh, Daniel Rayson and Penny J. Barnes
The Breast Journal 2010, 16;4:377–383
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There are limited data to guide clinical management when flat epithelial atypia (FEA) is identified in breast needle core biopsies (NCBs). Our objectives were to determine the frequency of malignancy in subsequent breast excisions following NCB diagnosis of FEA, and to characterize the pathological and clinical features of associated tumors.
Two hundred and fifty-six breast NCBs from a retrospective search (January 1999–July 2007) were blindly reviewed for FEA/other columnar cell lesions (CCLs). NCBs with co-existing carcinoma were excluded. The study included 211 NCBs: 116 (55%) with CCLs without atypia; 40 (19%) with CCLs with atypical ductal hyperplasia (ADH), 15 (7%) with FEA and 40 (19%) with FEA and ADH; 94 cases had follow-up excisions. Ductal carcinoma in situ and/or invasive carcinoma were present in: 4/26 (15%) excisions with CCLs on NCB, 11/30 (37%) with CCLs + ADH, 1/7 (14%) with FEA alone, and 9/31 (29%) with FEA + ADH. (a) FEA was more frequently seen with ADH, than without ADH in NCBs, (b) FEA and CCLs were more frequently associated with malignancy when with ADH, and (c) tumors excised following NCB diagnosis of FEA+/−ADH had favorable prognostic factors.
A conservative excision is warranted following a NCB diagnosis of FEA and ADH, and may be warranted for FEA alone
Tsu-Yee Joseph Lee, Rebecca F. MacIntosh, Daniel Rayson and Penny J. Barnes
The Breast Journal 2010, 16;4:377–383
Link to Journal
There are limited data to guide clinical management when flat epithelial atypia (FEA) is identified in breast needle core biopsies (NCBs). Our objectives were to determine the frequency of malignancy in subsequent breast excisions following NCB diagnosis of FEA, and to characterize the pathological and clinical features of associated tumors.
Two hundred and fifty-six breast NCBs from a retrospective search (January 1999–July 2007) were blindly reviewed for FEA/other columnar cell lesions (CCLs). NCBs with co-existing carcinoma were excluded. The study included 211 NCBs: 116 (55%) with CCLs without atypia; 40 (19%) with CCLs with atypical ductal hyperplasia (ADH), 15 (7%) with FEA and 40 (19%) with FEA and ADH; 94 cases had follow-up excisions. Ductal carcinoma in situ and/or invasive carcinoma were present in: 4/26 (15%) excisions with CCLs on NCB, 11/30 (37%) with CCLs + ADH, 1/7 (14%) with FEA alone, and 9/31 (29%) with FEA + ADH. (a) FEA was more frequently seen with ADH, than without ADH in NCBs, (b) FEA and CCLs were more frequently associated with malignancy when with ADH, and (c) tumors excised following NCB diagnosis of FEA+/−ADH had favorable prognostic factors.
A conservative excision is warranted following a NCB diagnosis of FEA and ADH, and may be warranted for FEA alone
Role of Fusion of Prone FDG-PET and Magnetic Resonance Imaging of the Breasts in the Evaluation of Breast Cancer
Role of Fusion of Prone FDG-PET and Magnetic Resonance Imaging of the Breasts in the Evaluation of Breast Cancer
Linda Moy, Marilyn E. Noz, Gerald Q. Maguire Jr, Amy Melsaether, Abby E. Deans, Antoinette D. Murphy-Walcott and Fabio Ponzo
The Breast Journal 2010, 16;4:369–376
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The purpose of this study is to report further about the statistically significant results from a prospective study, which suggests that fusion of prone F-18 Fluoro-deoxy-glucose (FDG) positron emission tomography (PET) and magnetic resonance (MR) breast scans increases the positive predictive value (PPV) and specificity for patients in whom the MR outcome alone would be nonspecific. Thirty-six women (mean age, 43 years; range, 24–65 years) with 90 lesions detected on MR consented to undergo a FDG-PET scan.
Two blinded readers evaluated the MR and the computer tomography (CT) attenuation-corrected prone FDG-PET scans side-by-side, then after the volumes were superimposed (fused). A semiautomatic, landmark-based program was used to perform nonrigid fusion. Pathology and radiologic follow-up were used as the reference standard. The sensitivity, specificity, PPV, negative predictive value (NPV), and accuracy (with 95% confidence intervals) for MR alone, FDG-PET alone, and fused MR and FDG-PET were calculated.
The median lesion size measured from the MR was 2.5 cm (range, 0.5–10 cm). Histologically, 56 lesions were malignant, and 15 were benign. Nineteen lesions were benign after 20–47 months of clinical and radiologic surveillance. The sensitivity of MR alone was 95%, FDG-PET alone was 57%, and fusion was 83%. The increase in PPV from 77% in MR alone to 98% when fused and the increase in specificity from 53% to 97% were statistically significant (p < 0.05). The false-negative rate on FDG-PET alone was 26.7%, and after fusion this number was reduced to 9%.
FDG-PET and MR fusions were helpful in selecting which lesion to biopsy, especially in women with multiple suspicious MR breast lesions
Linda Moy, Marilyn E. Noz, Gerald Q. Maguire Jr, Amy Melsaether, Abby E. Deans, Antoinette D. Murphy-Walcott and Fabio Ponzo
The Breast Journal 2010, 16;4:369–376
Link to Journal
The purpose of this study is to report further about the statistically significant results from a prospective study, which suggests that fusion of prone F-18 Fluoro-deoxy-glucose (FDG) positron emission tomography (PET) and magnetic resonance (MR) breast scans increases the positive predictive value (PPV) and specificity for patients in whom the MR outcome alone would be nonspecific. Thirty-six women (mean age, 43 years; range, 24–65 years) with 90 lesions detected on MR consented to undergo a FDG-PET scan.
Two blinded readers evaluated the MR and the computer tomography (CT) attenuation-corrected prone FDG-PET scans side-by-side, then after the volumes were superimposed (fused). A semiautomatic, landmark-based program was used to perform nonrigid fusion. Pathology and radiologic follow-up were used as the reference standard. The sensitivity, specificity, PPV, negative predictive value (NPV), and accuracy (with 95% confidence intervals) for MR alone, FDG-PET alone, and fused MR and FDG-PET were calculated.
The median lesion size measured from the MR was 2.5 cm (range, 0.5–10 cm). Histologically, 56 lesions were malignant, and 15 were benign. Nineteen lesions were benign after 20–47 months of clinical and radiologic surveillance. The sensitivity of MR alone was 95%, FDG-PET alone was 57%, and fusion was 83%. The increase in PPV from 77% in MR alone to 98% when fused and the increase in specificity from 53% to 97% were statistically significant (p < 0.05). The false-negative rate on FDG-PET alone was 26.7%, and after fusion this number was reduced to 9%.
FDG-PET and MR fusions were helpful in selecting which lesion to biopsy, especially in women with multiple suspicious MR breast lesions
Disentangling the Roles of Mammographic Screening and HRT in Recent Breast Cancer Incidence Trends in Italy by Analyses Based on Calendar Time and Time Since Screening Activation
Disentangling the Roles of Mammographic Screening and HRT in Recent Breast Cancer Incidence Trends in Italy by Analyses Based on Calendar Time and Time Since Screening Activation
Emanuele Crocetti, Carlotta Buzzoni, Fabio Falcini, Laura Cortesi, Vincenzo De Lisi, Stefano Ferretti, Rosario Tumino, Antonio Russo and Eugenio Paci
The Breast Journal 2010, 16;4:350–355
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The aim of the study was to evaluate the roles of screening activation and hormone replacement therapy discontinuation on the recent declining breast cancer incidence trends in Italy. We analyzed 41,358 invasive female breast cancers incident during 1991–2004 in six Italian population-based cancer registries.
Overall and age-specific incidence trends were evaluated using Joinpoint analysis. In addition to calendar years, data were analyzed on a years-since-screening-activation basis. Annual percentage change of standardized rates was computed. There were statistically significant increasing trends for women 40–44 and 45–49 years that did not change after screening activation. On the contrary, for women 50–69 years old and for those 70+ years, the increasing trends flattened around 2 years after screening activation. The prevalence of hormone replacement therapy use in Italy is and was rather low.
In conclusion, the recent tendency toward stabilization observed in Italy for female breast cancer incidence rates in women aged 50 years or more follows the introduction of mammographic screening
Emanuele Crocetti, Carlotta Buzzoni, Fabio Falcini, Laura Cortesi, Vincenzo De Lisi, Stefano Ferretti, Rosario Tumino, Antonio Russo and Eugenio Paci
The Breast Journal 2010, 16;4:350–355
Link to Journal
The aim of the study was to evaluate the roles of screening activation and hormone replacement therapy discontinuation on the recent declining breast cancer incidence trends in Italy. We analyzed 41,358 invasive female breast cancers incident during 1991–2004 in six Italian population-based cancer registries.
Overall and age-specific incidence trends were evaluated using Joinpoint analysis. In addition to calendar years, data were analyzed on a years-since-screening-activation basis. Annual percentage change of standardized rates was computed. There were statistically significant increasing trends for women 40–44 and 45–49 years that did not change after screening activation. On the contrary, for women 50–69 years old and for those 70+ years, the increasing trends flattened around 2 years after screening activation. The prevalence of hormone replacement therapy use in Italy is and was rather low.
In conclusion, the recent tendency toward stabilization observed in Italy for female breast cancer incidence rates in women aged 50 years or more follows the introduction of mammographic screening
Friday, 7 May 2010
Follow-up of Probably Benign Lesions (BI-RADS 3 category) in Breast MR Imaging
Follow-up of Probably Benign Lesions (BI-RADS 3 category) in Breast MR Imaging
Elke Hauth, Lale Umutlu, Sherko Kümmel, Rainer Kimmig, Michael Forsting
The Breast Journal 2010.16;3;:297-304
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The purpose of our study was to determine the frequency of BI-RADS 3 lesions in breast MR imaging in a clinical patient population and their frequency of malignancy in follow-up breast MR imaging.
In 44/698 (6.3%) patients with breast MR imaging, 56 lesions were categorized to BI-RADS 3. These lesions were all not palpable and not detectable at conventional mammography or ultrasound. In follow-up, lesions were score in complete resolved (CRL), partial resolved (PRL), stable lesions (SL), and progressive lesions (PL). Initial signal enhancement of lesions was coded by color intensity (bright for high, medium for medium, dark for low), the postinitial signal enhancement by color hue (blue for increase, green for plateau, red for wash-out). In first follow-up breast MR imaging 23/56 (41%) lesions were PRL, 14/56 (25%) lesions were CRL, 14/56 (25%) lesions remained SL. In one of five PL lesions, histopathology revealed a malignant tumor. In initial breast MR imaging, CRL showed significant fewer high pixels (p = 0.002), medium pixels (p = 0.006) significant more low pixels (p = 0.005) and significant more increase pixels (p = 0.037) than PRL.
In a clinical patient population the frequency of malignancy of BI-RADS 3 lesions in breast MR imaging and their frequency of malignancy are similar to that in conventional mammography.
In initial breast MR imaging, complete resolved lesions showed less suspicious contrast kinetics than other lesions. In follow-up, the increase of lesion size should warrant histopathological diagnosis.
Elke Hauth, Lale Umutlu, Sherko Kümmel, Rainer Kimmig, Michael Forsting
The Breast Journal 2010.16;3;:297-304
Link to Journal
The purpose of our study was to determine the frequency of BI-RADS 3 lesions in breast MR imaging in a clinical patient population and their frequency of malignancy in follow-up breast MR imaging.
In 44/698 (6.3%) patients with breast MR imaging, 56 lesions were categorized to BI-RADS 3. These lesions were all not palpable and not detectable at conventional mammography or ultrasound. In follow-up, lesions were score in complete resolved (CRL), partial resolved (PRL), stable lesions (SL), and progressive lesions (PL). Initial signal enhancement of lesions was coded by color intensity (bright for high, medium for medium, dark for low), the postinitial signal enhancement by color hue (blue for increase, green for plateau, red for wash-out). In first follow-up breast MR imaging 23/56 (41%) lesions were PRL, 14/56 (25%) lesions were CRL, 14/56 (25%) lesions remained SL. In one of five PL lesions, histopathology revealed a malignant tumor. In initial breast MR imaging, CRL showed significant fewer high pixels (p = 0.002), medium pixels (p = 0.006) significant more low pixels (p = 0.005) and significant more increase pixels (p = 0.037) than PRL.
In a clinical patient population the frequency of malignancy of BI-RADS 3 lesions in breast MR imaging and their frequency of malignancy are similar to that in conventional mammography.
In initial breast MR imaging, complete resolved lesions showed less suspicious contrast kinetics than other lesions. In follow-up, the increase of lesion size should warrant histopathological diagnosis.
Mammographic Density, Estrogen Receptor Status and Other Breast Cancer Tumor Characteristics
Mammographic Density, Estrogen Receptor Status and Other Breast Cancer Tumor Characteristics
Jane Ding, Ruth Warren, Anne Girling, Deborah Thompson, Douglas Easton
The Breast Journal 2010. 16;3;:279-289
Link to Journal
Mammographic density was a stronger risk factor for ER positive [OR = 2.94; 95% CI = 1.94–4.43; p < 0.001] than ER negative cancers when comparing breasts with greater than 50% dense region to those with less than 10% density. No other tumor characteristic had a significant correlation with breast density. These results suggest that mammographic percent density may be more strongly related to ER positive than ER negative breast cancer, but otherwise is a risk factor for breast cancer independent of other tumor characteristics
Jane Ding, Ruth Warren, Anne Girling, Deborah Thompson, Douglas Easton
The Breast Journal 2010. 16;3;:279-289
Link to Journal
Mammographic density was a stronger risk factor for ER positive [OR = 2.94; 95% CI = 1.94–4.43; p < 0.001] than ER negative cancers when comparing breasts with greater than 50% dense region to those with less than 10% density. No other tumor characteristic had a significant correlation with breast density. These results suggest that mammographic percent density may be more strongly related to ER positive than ER negative breast cancer, but otherwise is a risk factor for breast cancer independent of other tumor characteristics
Sensitivity and Specificity of Unilateral Edema on T2w-TSE Sequences in MR-Mammography Considering 974 Histologically Verified Lesions
Sensitivity and Specificity of Unilateral Edema on T2w-TSE Sequences in MR-Mammography Considering 974 Histologically Verified Lesions
Pascal A. T. Baltzer, Fan Yang, Matthias Dietzel, Aimée Herzog, Anke Simon, Tibor Vag, Mieczyslaw Gajda, Oumar Camara, Werner Alois Kaiser
The Breast Journal 2010. 16;3;:233–239
Link to Journal
Perifocal edema is specifically associated with malignancy and can therefore help to differentiate between benign and malignant breast disease. Furthermore, edema is associated with a higher grading and increased tumor size. These observations may be of prognostic value and should be considered in future investigations
Edema exhibits a clear signal difference to the surrounding tissue. This fact may be useful to quantify the amount of edema in the tissue analyzed.
Further study combining several morphologic and dynamic criteria is needed to fully estimate the full value of edema for MRM
Pascal A. T. Baltzer, Fan Yang, Matthias Dietzel, Aimée Herzog, Anke Simon, Tibor Vag, Mieczyslaw Gajda, Oumar Camara, Werner Alois Kaiser
The Breast Journal 2010. 16;3;:233–239
Link to Journal
Perifocal edema is specifically associated with malignancy and can therefore help to differentiate between benign and malignant breast disease. Furthermore, edema is associated with a higher grading and increased tumor size. These observations may be of prognostic value and should be considered in future investigations
Edema exhibits a clear signal difference to the surrounding tissue. This fact may be useful to quantify the amount of edema in the tissue analyzed.
Further study combining several morphologic and dynamic criteria is needed to fully estimate the full value of edema for MRM
Monday, 15 March 2010
Hydatid Disease of the Breast
Hydatid Disease of the Breast
Gurkan Ozturk, Mehmet Ozturk, Esref Kabalak
The Breast Journal 2010 16;2:204-5
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Breast involvement can be a part of disseminated hydaditosis or present as primary breast hydatid disease. Isolated breast involvement is reported to be rare, accounting for only 0.27% of the localizations of the cyst and 0.3% of the breast masses. Making a diagnosis of a primary breast hydatid cyst prior to surgery is difficult. There were characteristic ring-shaped structures inside the mass; this was attributed to the difference in the density of the walls and the contents of the daughter cysts inside the fluid-filled hydatid cysts. Such an overpenetrated view might be recommended in endemic areas if fine needle aspiration cytology and/or breast ultrasound results were suggestive of hydatid disease. Complete excision of the cyst is recommended for diagnostic pathological evaluation and treatment.
Gurkan Ozturk, Mehmet Ozturk, Esref Kabalak
The Breast Journal 2010 16;2:204-5
Link to Journal
Breast involvement can be a part of disseminated hydaditosis or present as primary breast hydatid disease. Isolated breast involvement is reported to be rare, accounting for only 0.27% of the localizations of the cyst and 0.3% of the breast masses. Making a diagnosis of a primary breast hydatid cyst prior to surgery is difficult. There were characteristic ring-shaped structures inside the mass; this was attributed to the difference in the density of the walls and the contents of the daughter cysts inside the fluid-filled hydatid cysts. Such an overpenetrated view might be recommended in endemic areas if fine needle aspiration cytology and/or breast ultrasound results were suggestive of hydatid disease. Complete excision of the cyst is recommended for diagnostic pathological evaluation and treatment.
Imaging Features of Bilateral Lupus Mastitis
Imaging Features of Bilateral Lupus Mastitis
Yen-Chi Wang, Chen-Pin Chou, Robin B. Levenson, Pin-Pen Hsieh, Jer-Shyung Huang, Huay-Ben Pan
The Breast Journal 2010 16;2:203-4
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Lupus mastitis is a rare disease. Only a few cases with imaging findings have been reported. Women are affected by lupus mastitis more commonly than men, usually between the ages of 20 and 50 years. Lupus mastitis is known as chronic inflammation of the subcutaneous fat of the breast. The main mammographic finding is prominent coarse calcifications because of subcutaneous fat necrosis. Breast ultrasound may demonstrate hyperechoic foci representing calcifications, ill-defined echogenic areas, or breast masses.
In young female SLE patients showing mastalgia and coarse calcifications on mammography, lupus mastitis should be an important differential diagnosis consideration, as it can be managed medically.
Yen-Chi Wang, Chen-Pin Chou, Robin B. Levenson, Pin-Pen Hsieh, Jer-Shyung Huang, Huay-Ben Pan
The Breast Journal 2010 16;2:203-4
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Lupus mastitis is a rare disease. Only a few cases with imaging findings have been reported. Women are affected by lupus mastitis more commonly than men, usually between the ages of 20 and 50 years. Lupus mastitis is known as chronic inflammation of the subcutaneous fat of the breast. The main mammographic finding is prominent coarse calcifications because of subcutaneous fat necrosis. Breast ultrasound may demonstrate hyperechoic foci representing calcifications, ill-defined echogenic areas, or breast masses.
In young female SLE patients showing mastalgia and coarse calcifications on mammography, lupus mastitis should be an important differential diagnosis consideration, as it can be managed medically.
An Extensive Breast Hematoma Following Stereotactic 9 Gauge Vacuum Assisted Large-Core Biopsy
An Extensive Breast Hematoma Following Stereotactic 9 Gauge Vacuum Assisted Large-Core Biopsy
Lee Pheng Yap, Hannah Rouse, Jennifer Cawson
The Breast 2010 16;2:199-200
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Vacuum assisted large-core biopsy is a widely used procedure for performing biopsy of suspicious breast lesions. However, it seems intuitive that the larger incised area of tissue with larger gauge biopsy devices increases hematoma risk. Whereas better tissue samples are obtained, the risk of bleeding is likely to be increased. Our patient had been on warfarin, although blood tests were in normal range before and after the procedure, and she was elderly and obese which are risk factors for wound hematomas.
Large core devices are unnecessary when smaller gauge needle core biopsy can achieve the diagnosis, at lower cost and morbidity. This case was amenable to 14G core biopsy, which is highly sensitive in most cases, and complications may have been avoided. The lesion type and patient risk factors should be considered and the biopsy procedure tailored to the individual case.
Lee Pheng Yap, Hannah Rouse, Jennifer Cawson
The Breast 2010 16;2:199-200
Link to Journal
Vacuum assisted large-core biopsy is a widely used procedure for performing biopsy of suspicious breast lesions. However, it seems intuitive that the larger incised area of tissue with larger gauge biopsy devices increases hematoma risk. Whereas better tissue samples are obtained, the risk of bleeding is likely to be increased. Our patient had been on warfarin, although blood tests were in normal range before and after the procedure, and she was elderly and obese which are risk factors for wound hematomas.
Large core devices are unnecessary when smaller gauge needle core biopsy can achieve the diagnosis, at lower cost and morbidity. This case was amenable to 14G core biopsy, which is highly sensitive in most cases, and complications may have been avoided. The lesion type and patient risk factors should be considered and the biopsy procedure tailored to the individual case.
True Recurrences and New Primary Tumors Have Different Clinical Features in Invasive Breast Cancer Patients with Ipsilateral Breast Tumor Relapse Afte
True Recurrences and New Primary Tumors Have Different Clinical Features in Invasive Breast Cancer Patients with Ipsilateral Breast Tumor Relapse After Breast-Conserving Treatment
Takashi Yoshida, Hiroyuki Takei, Masafumi Kurosumi, Jun Ninomiya, Yuko Ishikawa, Yuji Hayashi, Katsunori Tozuka, Hanako Oba, Kaori Kawanowa, Kenichi Inoue, Toshio Tabei
The Breast Journal 2010 16;2:127-133
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Ipsilateral breast tumor relapse (IBTR) after breast-conserving treatment (BCT) may represent two distinct types of lesion, including a true recurrence (TR) or a new primary tumor (NPT). The aim of this study was to ascertain the difference between TRs and NPTs and to show the clinical significance of classifying IBTR into these two types of recurrence.
Patients (n = 2,075) with unilateral invasive breast cancer who underwent BCT between 1987 and 2005 at Saitama Cancer Center were analyzed. IBTR was classified into TR and NPT, which was based on all clinical and pathological features of both a primary tumor and IBTR that can be evaluated. IBTR-free survival and the risk factors were analyzed in order to compare the findings for TR and NPT. In addition, the salvage surgical methods for IBTR and overall survival after IBTR were analyzed. Sixty patients with IBTR were classified into 52 with TR and eight with NPT. IBTR-free survival was significantly shorter in the patients with TR than those with NPT. Young age, tumor size, a positive surgical margin, and omission of radiation therapy (RT) were significant risk factors for TR. Omission of RT was the only significant risk factor for NPT. In 27 patients who underwent a repeat lumpectomy for TR, four had a second IBTR.
The overall survival after IBTR was worse in patients with TR than NPT. TR and NPT show quite different clinical features. Classifying IBTR into TR or NPT can therefore help to select the most appropriate treatment for IBTR
Takashi Yoshida, Hiroyuki Takei, Masafumi Kurosumi, Jun Ninomiya, Yuko Ishikawa, Yuji Hayashi, Katsunori Tozuka, Hanako Oba, Kaori Kawanowa, Kenichi Inoue, Toshio Tabei
The Breast Journal 2010 16;2:127-133
Link to Journal
Ipsilateral breast tumor relapse (IBTR) after breast-conserving treatment (BCT) may represent two distinct types of lesion, including a true recurrence (TR) or a new primary tumor (NPT). The aim of this study was to ascertain the difference between TRs and NPTs and to show the clinical significance of classifying IBTR into these two types of recurrence.
Patients (n = 2,075) with unilateral invasive breast cancer who underwent BCT between 1987 and 2005 at Saitama Cancer Center were analyzed. IBTR was classified into TR and NPT, which was based on all clinical and pathological features of both a primary tumor and IBTR that can be evaluated. IBTR-free survival and the risk factors were analyzed in order to compare the findings for TR and NPT. In addition, the salvage surgical methods for IBTR and overall survival after IBTR were analyzed. Sixty patients with IBTR were classified into 52 with TR and eight with NPT. IBTR-free survival was significantly shorter in the patients with TR than those with NPT. Young age, tumor size, a positive surgical margin, and omission of radiation therapy (RT) were significant risk factors for TR. Omission of RT was the only significant risk factor for NPT. In 27 patients who underwent a repeat lumpectomy for TR, four had a second IBTR.
The overall survival after IBTR was worse in patients with TR than NPT. TR and NPT show quite different clinical features. Classifying IBTR into TR or NPT can therefore help to select the most appropriate treatment for IBTR
In Newly Diagnosed Breast Cancer, Screening MRI of the Contralateral Breast Detects Mammographically Occult Cancer, Even in Elderly Women: The Mayo Cl
In Newly Diagnosed Breast Cancer, Screening MRI of the Contralateral Breast Detects Mammographically Occult Cancer, Even in Elderly Women: The Mayo Clinic in Florida Experience
Johnny Ray Bernard Jr, Laura A. Vallow, Elizabeth R. DePeri, Rebecca B. McNeil, Deborah G. Feigel, Surabhi Amar, Steven J. Buskirk, Edith A. Perez
The Breast Journal 2010 16;2:118-126
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The role of magnetic resonance imaging (MRI) in patients with newly diagnosed breast cancer is somewhat controversial. The purpose of this study was to evaluate the prevalence of synchronous, occult contralateral breast cancer detected by MRI but not by mammography or clinical breast examination in women with newly diagnosed breast cancer, including those aged 70 years or older at our institution.
MRI results for women with newly diagnosed breast cancer who underwent bilateral breast MRI after negative mammography and clinical examination between February 2003 and November 2007 at Mayo Clinic in Florida were reviewed. The prevalence of pathologically confirmed contralateral carcinoma diagnosed solely by MRI was determined and analyzed in the context of age, family history, menopausal status, breast density, and primary-tumor characteristics. Logistic regression was used to explore the association between contralateral carcinoma and potential patient risk factors.
A total of 425 women were evaluated, of whom 129 (30%) were aged 70 years or older. A contralateral biopsy was recommended and performed solely on the basis of MRI in 72 of the 425 women (17%). Sixteen of these 72 women (22%) had pathologically confirmed carcinoma, including seven in the older subgroup. The prevalence of clinically and mammographically occult contralateral carcinoma detected by MRI was 3.8% (16/425) overall and 5.4% (7/129) in the group of older women. When potential risk factors for contralateral breast cancer were evaluated, postmenopausal status was the only significant predictor of contralateral cancer detected by MRI (p = 0.016).
We concluded that contralateral breast screening with MRI should be considered in postmenopausal women with newly diagnosed breast cancer, even those aged 70 years or older at diagnosis
Johnny Ray Bernard Jr, Laura A. Vallow, Elizabeth R. DePeri, Rebecca B. McNeil, Deborah G. Feigel, Surabhi Amar, Steven J. Buskirk, Edith A. Perez
The Breast Journal 2010 16;2:118-126
Link to Journal
The role of magnetic resonance imaging (MRI) in patients with newly diagnosed breast cancer is somewhat controversial. The purpose of this study was to evaluate the prevalence of synchronous, occult contralateral breast cancer detected by MRI but not by mammography or clinical breast examination in women with newly diagnosed breast cancer, including those aged 70 years or older at our institution.
MRI results for women with newly diagnosed breast cancer who underwent bilateral breast MRI after negative mammography and clinical examination between February 2003 and November 2007 at Mayo Clinic in Florida were reviewed. The prevalence of pathologically confirmed contralateral carcinoma diagnosed solely by MRI was determined and analyzed in the context of age, family history, menopausal status, breast density, and primary-tumor characteristics. Logistic regression was used to explore the association between contralateral carcinoma and potential patient risk factors.
A total of 425 women were evaluated, of whom 129 (30%) were aged 70 years or older. A contralateral biopsy was recommended and performed solely on the basis of MRI in 72 of the 425 women (17%). Sixteen of these 72 women (22%) had pathologically confirmed carcinoma, including seven in the older subgroup. The prevalence of clinically and mammographically occult contralateral carcinoma detected by MRI was 3.8% (16/425) overall and 5.4% (7/129) in the group of older women. When potential risk factors for contralateral breast cancer were evaluated, postmenopausal status was the only significant predictor of contralateral cancer detected by MRI (p = 0.016).
We concluded that contralateral breast screening with MRI should be considered in postmenopausal women with newly diagnosed breast cancer, even those aged 70 years or older at diagnosis
Routine Breast MRI as a Screening Modality for Occult Contralateral Breast Cancer: Where Do We Draw the Line?
Routine Breast MRI as a Screening Modality for Occult Contralateral Breast Cancer: Where Do We Draw the Line?
Christine Dauphine, Iraj Khalkhali
The Breast Journal 2010 16;2:115-117
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It is clear that there is some benefit to performing MRI in breast cancer patients, looking for contralateral cancers. But at what cost? The results of the analyses by Bernard et al. suggest that selective use is possible. We hope that further studies are undertaken to include minority patients, larger numbers overall, and to continue looking at predictive factors to help determine where MRI would be the most useful
Christine Dauphine, Iraj Khalkhali
The Breast Journal 2010 16;2:115-117
Link to Journal
It is clear that there is some benefit to performing MRI in breast cancer patients, looking for contralateral cancers. But at what cost? The results of the analyses by Bernard et al. suggest that selective use is possible. We hope that further studies are undertaken to include minority patients, larger numbers overall, and to continue looking at predictive factors to help determine where MRI would be the most useful
Interstitial Laser Therapy of Breast Fibroadenomas With 6 and 8 Year Follow-Up
Interstitial Laser Therapy of Breast Fibroadenomas With 6 and 8 Year Follow-Up
K. Dowlatshahi, S. Wadhwani, R. Alvarado, C. Valadez, J. Dieschbourg
The Breast Journal 2010 16;1:73-76
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Fibroadenomas are non-cancerous breast tumors commonly seen in teenagers but also found in women at the time of first mammogram. They have distinct physical findings and imaging features but the definitive diagnosis is made by ultrasound or stereotactic guided needle biopsy.
Treatment options are observation or surgical removal. Recently, removal by ultrasound-guided technique has been reported. Alternatively, the tumor may be ablated within the breast by cold (cryotherapy) or by heat (laser, radiofrequency, focused ultrasound and microwave).
In this paper the laser treatment in two patients, one with bilateral fibroadenomas, with 6 and 8 year follow-up is presented.
The is a minimally invasive image-guided laser treatment of breast fibroadenoma and long term follow-up in two patients; one with single and the other with multiple bilateral tumors. The treatment is an office-based procedure given under local anesthesia with minimal pain and discomfort. It is esthetically superior to lumpectomy
K. Dowlatshahi, S. Wadhwani, R. Alvarado, C. Valadez, J. Dieschbourg
The Breast Journal 2010 16;1:73-76
Link to Journal
Fibroadenomas are non-cancerous breast tumors commonly seen in teenagers but also found in women at the time of first mammogram. They have distinct physical findings and imaging features but the definitive diagnosis is made by ultrasound or stereotactic guided needle biopsy.
Treatment options are observation or surgical removal. Recently, removal by ultrasound-guided technique has been reported. Alternatively, the tumor may be ablated within the breast by cold (cryotherapy) or by heat (laser, radiofrequency, focused ultrasound and microwave).
In this paper the laser treatment in two patients, one with bilateral fibroadenomas, with 6 and 8 year follow-up is presented.
The is a minimally invasive image-guided laser treatment of breast fibroadenoma and long term follow-up in two patients; one with single and the other with multiple bilateral tumors. The treatment is an office-based procedure given under local anesthesia with minimal pain and discomfort. It is esthetically superior to lumpectomy
Flat Epithelial Atypia and Atypical Ductal Hyperplasia: Carcinoma Underestimation Rate
Flat Epithelial Atypia and Atypical Ductal Hyperplasia: Carcinoma Underestimation Rate
Anna Ingegnoli, Cecilia d'Aloia, Antonia Frattaruolo, Lara Pallavera, Eugenia Martella, Girolamo Crisi, Maurizio Zompatori
The Breast Journal 2010 16;1:55-59
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This study was carried out to determine the underestimation rate of carcinoma upon surgical biopsy after a diagnosis of flat epithelial atypia and atypical ductal hyperplasia and 11-gauge vacuum-assisted breast biopsy.
A retrospective review was conducted of 476 vacuum-assisted breast biopsy performed from May 2005 to January 2007 and a total of 70 cases of atypia were identified. Fifty cases (71%) were categorized as pure atypical ductal hyperplasia, 18 (26%) as pure flat epithelial atypia and two (3%) as concomitant flat epithelial atypia and atypical ductal hyperplasia. Each group were compared with the subsequent open surgical specimens. Surgical biopsy was performed in 44 patients with atypical ductal hyperplasia, 15 patients with flat epithelial atypia, and two patients with flat epithelial atypia and atypical ductal hyperplasia. Five cases of atypical ductal hyperplasia were upgraded to ductal carcinoma in situ, three cases of flat epithelial atypia yielded one ductal carcinoma in situ and two cases of invasive ductal carcinoma, and one case of flat epithelial atypia/atypical ductal hyperplasia had invasive ductal carcinoma. The overall rate of malignancy was 16% for atypical ductal hyperplasia (including flat epithelial atypia/atypical ductal hyperplasia patients) and 20% for flat epithelial atypia.
The presence of flat epithelial atypia and atypical ductal hyperplasia at biopsy requires careful consideration, and surgical excision should be suggested.
Anna Ingegnoli, Cecilia d'Aloia, Antonia Frattaruolo, Lara Pallavera, Eugenia Martella, Girolamo Crisi, Maurizio Zompatori
The Breast Journal 2010 16;1:55-59
Link to Journal
This study was carried out to determine the underestimation rate of carcinoma upon surgical biopsy after a diagnosis of flat epithelial atypia and atypical ductal hyperplasia and 11-gauge vacuum-assisted breast biopsy.
A retrospective review was conducted of 476 vacuum-assisted breast biopsy performed from May 2005 to January 2007 and a total of 70 cases of atypia were identified. Fifty cases (71%) were categorized as pure atypical ductal hyperplasia, 18 (26%) as pure flat epithelial atypia and two (3%) as concomitant flat epithelial atypia and atypical ductal hyperplasia. Each group were compared with the subsequent open surgical specimens. Surgical biopsy was performed in 44 patients with atypical ductal hyperplasia, 15 patients with flat epithelial atypia, and two patients with flat epithelial atypia and atypical ductal hyperplasia. Five cases of atypical ductal hyperplasia were upgraded to ductal carcinoma in situ, three cases of flat epithelial atypia yielded one ductal carcinoma in situ and two cases of invasive ductal carcinoma, and one case of flat epithelial atypia/atypical ductal hyperplasia had invasive ductal carcinoma. The overall rate of malignancy was 16% for atypical ductal hyperplasia (including flat epithelial atypia/atypical ductal hyperplasia patients) and 20% for flat epithelial atypia.
The presence of flat epithelial atypia and atypical ductal hyperplasia at biopsy requires careful consideration, and surgical excision should be suggested.
Breast Cancer Prevention: Patient Decision Making and Risk Communication in the High Risk Setting
Breast Cancer Prevention: Patient Decision Making and Risk Communication in the High Risk Setting
Elissa M. Ozanne, Eve Wittenberg, Judy E. Garber, Jane C. Weeks
The Breast Journal 2010 16;1:38-47
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The purpose of this study was to investigate prevention decision making among women at high risk for breast cancer, including patient preferences for preventive interventions, patient understanding of disease risk, and patient preferences for risk communication methods, and the corresponding physician understanding of these factors. A prospective interview and survey study was conducted of consecutive new patients seen at a cancer risk and prevention clinic and their physicians.
One hundred and forty-six of 217 eligible patients participated and completed all components of the study (67%), and they were seen by a four physicians. Women's preferences for prevention intervention varied widely across women but were stable across time. Physicians were very often unable to predict their patients' preferences for prevention efforts. Patients overestimated their risk of disease, and physicians overestimated the decrease in perceived risk resulting from counseling
As risk stratification for breast cancer improves, and prevention options become more tolerable, it becomes increasingly important to appropriately counsel women considering such options. This study provides insight into the decision making process of women at high risk for breast cancer and highlights the importance of addressing patient preferences for interventions and risk perception during risk assessment and counseling consultations
Elissa M. Ozanne, Eve Wittenberg, Judy E. Garber, Jane C. Weeks
The Breast Journal 2010 16;1:38-47
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The purpose of this study was to investigate prevention decision making among women at high risk for breast cancer, including patient preferences for preventive interventions, patient understanding of disease risk, and patient preferences for risk communication methods, and the corresponding physician understanding of these factors. A prospective interview and survey study was conducted of consecutive new patients seen at a cancer risk and prevention clinic and their physicians.
One hundred and forty-six of 217 eligible patients participated and completed all components of the study (67%), and they were seen by a four physicians. Women's preferences for prevention intervention varied widely across women but were stable across time. Physicians were very often unable to predict their patients' preferences for prevention efforts. Patients overestimated their risk of disease, and physicians overestimated the decrease in perceived risk resulting from counseling
As risk stratification for breast cancer improves, and prevention options become more tolerable, it becomes increasingly important to appropriately counsel women considering such options. This study provides insight into the decision making process of women at high risk for breast cancer and highlights the importance of addressing patient preferences for interventions and risk perception during risk assessment and counseling consultations
Clinical Implications of Subcategorizing BI-RADS 4 Breast Lesions associated with Microcalcification: A Radiology–Pathology Correlation Study
Clinical Implications of Subcategorizing BI-RADS 4 Breast Lesions associated with Microcalcification: A Radiology–Pathology Correlation Study
Mary Ann Sanders, Lane Roland, Sunati Sahoo
The Breast Journal 2010 16;1:28-31
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Currently radiologists have the option of subcategorizing BI-RADS 4 breast lesions into 4A (low suspicion for malignancy), 4B (intermediate suspicion of malignancy), and 4C (moderate concern, but not classic for malignancy).
To determine the clinical significance of BI-RADS 4 subcategories and the common pathologic changes associated with these mammographic lesions, a retrospective review of 239 consecutive stereotactic-needle core biopsies (SNCB) for microcalcifications was performed. All 239 SNCBs were BI-RADS 4 lesions, and of these, 191 were subcategorized to 4A, 4B or 4C.
Ninety-four of 191 (49%) were 4A, 73 (38%) were 4B, and 24 (13%) were 4C.
Fibrocystic change was the most common finding (66/239; 28%) followed by ductal carcinoma in situ (DCIS) accounting for 23% of cases. This was followed by columnar cell alteration with or without atypia (47/239; 19%), and fibroadenoma (45/239; 19%).
While 70% (17/24) of BI-RADS 4C category lesions were DCIS, only 21% (15/73) of BI-RADS 4B and 10% (10/94) of BI-RADS 4A were DCIS.
Without sub-categorization, carcinoma was diagnosed in 23% (55/239) of all cases with BI-RADS 4. Therefore, subcategorizing BI-RADS 4 lesions is important since it not only benefits the patient and clinician in understanding the level of concern for carcinoma, but will also alert the pathologist
Mary Ann Sanders, Lane Roland, Sunati Sahoo
The Breast Journal 2010 16;1:28-31
Link to Journal
Currently radiologists have the option of subcategorizing BI-RADS 4 breast lesions into 4A (low suspicion for malignancy), 4B (intermediate suspicion of malignancy), and 4C (moderate concern, but not classic for malignancy).
To determine the clinical significance of BI-RADS 4 subcategories and the common pathologic changes associated with these mammographic lesions, a retrospective review of 239 consecutive stereotactic-needle core biopsies (SNCB) for microcalcifications was performed. All 239 SNCBs were BI-RADS 4 lesions, and of these, 191 were subcategorized to 4A, 4B or 4C.
Ninety-four of 191 (49%) were 4A, 73 (38%) were 4B, and 24 (13%) were 4C.
Fibrocystic change was the most common finding (66/239; 28%) followed by ductal carcinoma in situ (DCIS) accounting for 23% of cases. This was followed by columnar cell alteration with or without atypia (47/239; 19%), and fibroadenoma (45/239; 19%).
While 70% (17/24) of BI-RADS 4C category lesions were DCIS, only 21% (15/73) of BI-RADS 4B and 10% (10/94) of BI-RADS 4A were DCIS.
Without sub-categorization, carcinoma was diagnosed in 23% (55/239) of all cases with BI-RADS 4. Therefore, subcategorizing BI-RADS 4 lesions is important since it not only benefits the patient and clinician in understanding the level of concern for carcinoma, but will also alert the pathologist
Early Response to Neo-adjuvant Chemotherapy in Carcinoma of the Breast Predicts Both Successful Breast-Conserving Surgery and Decreased Risk of Ipsila
Early Response to Neo-adjuvant Chemotherapy in Carcinoma of the Breast Predicts Both Successful Breast-Conserving Surgery and Decreased Risk of Ipsilateral Breast Tumor Recurrence
Makoto Ishitobi, Yoshifumi Komoike, Kazuyoshi Motomura, Hiroki Koyama, Hideo Inaji
The Breast Journal 2010 16;1:9-13
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Multivariate analysis showed that the early response was a predictive factor of IBTR-free survival, being independent of other clinicopathological factors. In conclusion, the early response to neo-adjuvant chemotherapy may be a useful predictor of both selection of surgical method and IBTR risk
Makoto Ishitobi, Yoshifumi Komoike, Kazuyoshi Motomura, Hiroki Koyama, Hideo Inaji
The Breast Journal 2010 16;1:9-13
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Multivariate analysis showed that the early response was a predictive factor of IBTR-free survival, being independent of other clinicopathological factors. In conclusion, the early response to neo-adjuvant chemotherapy may be a useful predictor of both selection of surgical method and IBTR risk
Sentinel Lymph Node Detection in Breast Cancer Patients by Real-Time Virtual Sonography Constructed With Three-Dimensional Computed Tomography-Lymphog
Sentinel Lymph Node Detection in Breast Cancer Patients by Real-Time Virtual Sonography Constructed With Three-Dimensional Computed Tomography-Lymphography
Shigeru Yamamoto, Noriko Maeda, Michiko Tamesa, Yukiko Nagashima, Kazuyoshi Suga, Masaaki Oka
The Breast Journal 2010 16;1:4-8
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This is a first attempt at preoperatively identifying SLNs using US guided by the RVS system in breast cancer patients. Although evaluation of SLN metastases was unsatisfactory, this method may be useful for preoperative fine-needle aspiration cytology for diagnosis of SLN metastases
Shigeru Yamamoto, Noriko Maeda, Michiko Tamesa, Yukiko Nagashima, Kazuyoshi Suga, Masaaki Oka
The Breast Journal 2010 16;1:4-8
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This is a first attempt at preoperatively identifying SLNs using US guided by the RVS system in breast cancer patients. Although evaluation of SLN metastases was unsatisfactory, this method may be useful for preoperative fine-needle aspiration cytology for diagnosis of SLN metastases
How to Restore Public Trust about Breast Cancer Screening? An Opportunity to Reinforce the Need for Further Advances in Science and Technology and Acc
How to Restore Public Trust about Breast Cancer Screening? An Opportunity to Reinforce the Need for Further Advances in Science and Technology and Access to Care
Shahla Masood
Editorial
The Breast Journal 2010 16;1:1-3
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A call for rethinking what effectiveness means in response to USPSTF guidelines on mammography screening
Shahla Masood
Editorial
The Breast Journal 2010 16;1:1-3
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A call for rethinking what effectiveness means in response to USPSTF guidelines on mammography screening
Thursday, 21 January 2010
Breast Intracystic Papillary Carcinoma: An Update
Breast Intracystic Papillary Carcinoma: An Update
Julien Calderaro, Marc Espie, Juliette Duclos, Sylvie Giachetti, Delphine Wehrer, Wissam Sandid, Laurence Cahen-Doidy, Marcella Albiter, Anne Janin, Anne de Roquancourt
The Breast Journal Volume 15 Issue 6, Pages 639 - 644
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Intracystic papillary carcinoma (IPC), a breast tumor mainly occuring in the elderly, has long been considered as a variant of ductal carcinoma in situ (DCIS). This is now debated since metastatic cases have been reported.
In this study, surgical pieces of 20 IPCs were reassessed, and markers of myopepithelial layer (p63, CD10 and Smooth Muscle Actin) as well as estrogen receptors (ER) and progesterone receptors (PgR) and C-erb-B2 oncoprotein expression were systematically performed and quantified. In 10 cases, an associated unequivocal invasive component was found. In all 20 cases, no myoepithelial layer was found. Eighteen tumors were ER positive, 14 were PgR positive. Moreover, none of the tumors over-expressed C-erb-B2 oncoprotein. Therefore this study showed that in all cases of IPC there were microscopic features of invasive carcinoma despite good clinical prognostic indicators, and that precise characterization of tumors requires extensive paraffin embedding of surgical pieces
Julien Calderaro, Marc Espie, Juliette Duclos, Sylvie Giachetti, Delphine Wehrer, Wissam Sandid, Laurence Cahen-Doidy, Marcella Albiter, Anne Janin, Anne de Roquancourt
The Breast Journal Volume 15 Issue 6, Pages 639 - 644
Link to Journal
Intracystic papillary carcinoma (IPC), a breast tumor mainly occuring in the elderly, has long been considered as a variant of ductal carcinoma in situ (DCIS). This is now debated since metastatic cases have been reported.
In this study, surgical pieces of 20 IPCs were reassessed, and markers of myopepithelial layer (p63, CD10 and Smooth Muscle Actin) as well as estrogen receptors (ER) and progesterone receptors (PgR) and C-erb-B2 oncoprotein expression were systematically performed and quantified. In 10 cases, an associated unequivocal invasive component was found. In all 20 cases, no myoepithelial layer was found. Eighteen tumors were ER positive, 14 were PgR positive. Moreover, none of the tumors over-expressed C-erb-B2 oncoprotein. Therefore this study showed that in all cases of IPC there were microscopic features of invasive carcinoma despite good clinical prognostic indicators, and that precise characterization of tumors requires extensive paraffin embedding of surgical pieces
Quantitative Assessment of Radiation-Induced Fibrosis of the Breast with Tissue Compliance Meter, Palpation, and Radiological Imaging: Preliminary Res
Quantitative Assessment of Radiation-Induced Fibrosis of the Breast with Tissue Compliance Meter, Palpation, and Radiological Imaging: Preliminary Results
A. Gabriella Wernicke, Ruth Rosenblatt, Margarita Rasca, Preeti Parhar, Paul J. Christos, Andrew Fischer, Bhupesh Parashar, Dattatreyudu Nori
banner
The Breast Journal Volume 15 Issue 6, Pages 579 - 582
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This study is the first to explore the differences in radio-tracer uptake in the axilla in patients following BSGI and comparing the radio-tracer uptake in metasatic nodes versus extravasation of radio-tracer during injection.
The sensitivity of breast specific gamma imaging in detecting primary breast cancers has been shown, but its usefulness in the detection of axillary metastases has not been determined
A. Gabriella Wernicke, Ruth Rosenblatt, Margarita Rasca, Preeti Parhar, Paul J. Christos, Andrew Fischer, Bhupesh Parashar, Dattatreyudu Nori
banner
The Breast Journal Volume 15 Issue 6, Pages 579 - 582
Link to Journal
This study is the first to explore the differences in radio-tracer uptake in the axilla in patients following BSGI and comparing the radio-tracer uptake in metasatic nodes versus extravasation of radio-tracer during injection.
The sensitivity of breast specific gamma imaging in detecting primary breast cancers has been shown, but its usefulness in the detection of axillary metastases has not been determined
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